Acute chest pain — suspected ACS

PLAB 2 & PRES 3 · cardiology · hard · 8 minutes

Candidate brief

You are an FY2 doctor/SHO in the Emergency Department. Mr James Kelly, 59, developed severe central chest pain 40 minutes ago. Assess him, explain your concerns and initiate immediate management. Verbalise any examinations, investigations, treatments and escalation you would undertake.

What examiners look for

Treat suspected ACS as a time-critical emergency. Begin ABCDE, monitoring, IV access and urgent senior escalation while obtaining a focused history. Obtain a 12-lead ECG as soon as possible. A normal initial ECG does not exclude ACS; repeat ECGs if pain continues or the diagnosis remains uncertain. Give aspirin 300 mg promptly unless there is a true allergy or clear contraindication. Do not administer oxygen routinely when oxygen saturation is normal. Use the appropriate target for the patient. GTN may help pain when blood pressure is adequate and there are no contraindications, but improvement after GTN does not confirm ACS. An ECG showing STEMI requires immediate activation of the local reperfusion or primary-PCI pathway. Do not wait for troponin results. Consider alternative life-threatening diagnoses, including aortic dissection, pulmonary embolism and pneumothorax, without delaying ACS treatment when the presentation and ECG support STEMI.

Guideline references

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